Readmission Reduction

Hospitals work to lower number of Medicare patients readmitted

By Michael Waddell

Baptist Memorial Hospital-Memphis and The Regional Medical Center at Memphis are leading the pack in efforts to reduce patient readmissions with 30 days of hospital stays.

Dr. Todd Lang and Kenneth Booker converse at Baptist Memorial Hospital-Memphis admissions. The hospital has reduced readmissions and the fines associated with them.

(Memphis News/Andrew J. Breig)

This year Medicare will levy $227 million in penalties against hospitals across the country that performed below expectations for readmissions.

Baptist is one of only a few hospitals in Tennessee that did not incur a penalty for readmissions in either of the first two years of the program, and The MED received no readmissions penalty last year and only 0.03 percent penalty this year.

“We’re confident that next year’s results and the subsequent years’ will also come out favorably due to the things we’ve hardwired into our operations over the past year like post-discharge phone calls and bedside change of shift reporting that engage the patients and their families,” said Baptist administrator and CEO Derick Ziegler.

The penalties are assessed on comparative data of each hospital’s observed readmissions to the expected readmissions based on the severity of illness.

Approximately 2,225 hospitals will have Medicare payments reduced for a year starting Oct. 1. Eighteen hospitals will lose the maximum 2 percent, and another 154 will lose 1 percent or more of every payment for a patient stay.

In addition to a high number of readmissions, hospitals can also be penalized for high overall cost for Medicare beneficiaries resulting from longer hospital stays and for meaningful use criteria with electronic records.

Up to 8 percent of each hospital’s Medicare dollars are at risk for all categories combined.

“We have a heavy Medicare population, so an 8 percent penalty would be significant – somewhere near $14 million,” Ziegler said.

To tackle the issue head on, in 2008 Baptist joined a readmissions collaborative from the Institute for Healthcare Improvement and spent two years investigating best practices to prevent readmissions by deploying strategies and involving the local community.

This year Medicare will levy $227 million in penalties against hospitals that performed below expectations for readmissions.

“Our major success with this initiative is proactive response,” said Darla Belt, Baptist director of nursing and administrative director of quality.

First, Baptist defined its at-risk population, allowing it to look at patient readmissions by demographic. Then its multidisciplinary team looked at the patients’ social needs, discharge plans, the state of their chronic illness, follow-up appointments and even end-of-life planning.

Getting the discharge plan done within the first 24 hours of the patient’s admission is critical, according to Belt.

Baptist is now ranked in the top 10 percent in the country for overall readmissions. The hospital continually gathers useful data from readmission questionnaires given to every returning patient.

“We were able to isolate trends by time of day or with patients who live alone or those with anxiety,” said Belt, who is also a member of the Tennessee Hospital Association’s readmissions panel. “We have communication boards within the rooms for family concerns, and patients receive post-discharge phone calls to address things like whether they had any trouble making their appointment and any other issues.”

The MED also is keeping its Medicare readmissions rate low, thanks in part to having a smaller overall Medicare population compared to some other area hospitals.

“The Medicare readmissions penalty has been on our radar for quite some time, and we are working to better manage patients that have been discharged so they get the appropriate follow-ups and connect them with our primary care clinics to make sure they get the correct outpatient care,” said Dr. Reginald Coopwood, MED president and CEO.

The MED’s Medicare population measures roughly 12 percent to 15 percent, while Baptist’s is estimated at 67 percent to 70 percent.

“Although we do not have a high number of Medicare patients, a penalty would still be significant for us if we do not focus on it,” Coopwood said. “Any dollars we do not get is significant because of the high number of uninsured and under-insured that The MED takes care of.”

The uninsured currently make up 28 percent to 30 percent of The MED’s overall patient load.

Many local hospitals will receive a lower fine this year for Medicare readmissions, mimicking a national trend. The overall total for Medicare readmission fines is $53 million less this year compared to last, with 1,371 hospitals to receive a lower fine. Medicare is increasing penalties for 1,074 hospitals.